DRIVEFields

Normal visual-field context

Key factNormal binocular horizontal field is much wider than the minimum licensing thresholds.

Healthy monocular fields are wide, but the binocular field is wider still. Austroads describes that the binocular field is approximately 200 degrees horizontally, with the central overlapping field supporting stereopsis.

• This is why a driving-field assessment is usually interested in the combined functional field, not just each eye in isolation.
• A normal field has substantial temporal, nasal, superior, and inferior reach, but the licensing question is whether the remaining field meets the Austroads driving standard.
• Do not estimate the standard from anatomy alone. Use the actual test result when any defect, risk factor, or progressive disease is present.

Confrontation is only a screen

Key factAustroads allows confrontation screening, but it does not define a step-by-step confrontation technique.

Confrontation can be a minimum screen when there is no clinical indication of visual-field impairment and no progressive eye condition.

• Austroads says confrontation is satisfactory only as a screen when there is no clinical indication of visual-field impairment and no progressive eye condition; it also says confrontation is an inexact test.
• Austroads does not define the exact bedside technique. Use the usual clinical method: sit face-to-face at a similar eye level and distance, have the patient fixate your eye or nose, and compare their responses with your own field.
• Test one eye at a time with the other eye occluded. Present fingers or a small moving target in each quadrant and from the periphery toward fixation; ask the patient to report movement or finger number while maintaining fixation.
• If confrontation suggests a defect, or the history/examination raises concern, formal perimetry should be performed.
• Confrontation is not precise enough to measure 90, 110, or 140 degree driving thresholds.
• A progressive condition that could affect driving should not be cleared by confrontation alone.

When monocular automated static perimetry may be enough

Key factMonocular static perimetry is a low-risk rule-out pathway, not a way to measure a suspicious driving field.

Monocular automated static perimetry may be sufficient when there are no symptoms, family history, risk factors, progressive eye disease, or field concerns, and the static field shows no defect.

• This is a rule-out pathway, not a way to measure a suspicious driving field.
• If monocular static perimetry shows a significant defect, move to binocular Esterman or a validated equivalent.
• For a monocular patient, Transport for NSW may require the field to be reported in degrees, so an Esterman or equivalent is often the cleaner practical test in NSW even when testing the functioning eye.

When an Esterman or equivalent is the cleaner test

Key factIf there is a significant defect, progressive disease, or a degrees-based report is needed, use binocular Esterman or a validated equivalent.

Use binocular Esterman or a validated equivalent when there is a suspected peripheral defect, a significant monocular static-perimetry defect, a progressive condition with driving relevance, or a need to report the field in degrees.

• Austroads allows alternative devices only when they can show the required tested spots and fixation monitoring.
• The Optometry NSW/ACT guide gives Medmont binocular visual field printed in Level Map Mode as an example of an Esterman-equivalent approach.
• If the device, layout, or tested locations are uncertain, use manual review rather than treating the printout as automatically equivalent.

How the Esterman grid is built

Key factThe standard Humphrey-style grid has 120 tested points across 12 distinct y-coordinate rows.

The standard Humphrey-style binocular Esterman has 120 tested locations arranged across 12 distinct y-coordinate rows. The pattern is functional, not symmetrical, and it should not be redrawn as a regular square grid.

• Coordinates are described in degrees from fixation: negative x is left field, positive x is right field, positive y is superior field, and negative y is inferior field.
• The app grid can look like 11 visual rows because there is no scored y = 0 row, and the very sparse edge rows can visually merge with their neighbours. The canonical row coordinates are y = 36, 21, 10, 3, -3, -8, -13, -21, -30, -43, -53, and -57. The top row has two points; the two lowest rows also have two points each, but they sit close together near the inferior edge and can look like one small bottom cluster.
• The row pattern is sparse superiorly, denser through the horizontal band, and extends further inferiorly. DRIVE Fields uses the actual tested point coordinates rather than interpolating missing space.
• There is no scored point at fixation. The patient fixates centrally while surrounding points are presented.

Melbourne Rapid Fields 124-point layout

Key factMRF uses the standard Humphrey 120-point Esterman grid plus four extra 70-degree points.

In DRIVE Fields, MRF is entered on its own 124-point layout: the standard Humphrey 120-point Esterman grid plus four additional points at 70 degrees eccentricity to fill the far-horizontal gap between about 60 and 75 degrees.

• In DRIVE Fields the four extra 70-degree points are represented on the two Humphrey rows nearest the horizontal meridian: x = -70 and +70 at y = 3, and x = -70 and +70 at y = -3.
• False-positive and false-negative reliability indices are reported on the printout.
• Fixation monitoring is reported through a webcam-based gaze fixation stability plot. The stimulus is suprathreshold and the test should be entered on the MRF 124-point layout rather than the standard 120-point layout.
• MRF requires a sufficiently large screen and does not shift the fixation target to extend eccentricity; the patient maintains a consistent fixation position while stimuli are presented.

Henson 9000 Group 1 and Group 2 layouts

Key factHenson 9000 is not the Humphrey grid: Group 1 has its own 120-point lattice, and Group 2 adds four far-horizontal points.

DRIVE Fields uses a native Henson Group 1 grid for the 120-point car/van-style pathway and a native Group 2 grid for the 124-point heavy/public-service-style pathway.

• Group 1 is a 120-point Henson lattice with horizontal meridian points at y = 0 and midline-band rows at y = 6 and y = -6; it is not a cosmetic relabel of the Humphrey 120-point Esterman grid.
• Group 2 uses the same Henson Group 1 grid plus four extra far-horizontal points at x = -81 and +81 on y = 6 and y = -6.
• Only two exact test locations overlap with the standard Humphrey coordinate set, so the native Henson layout should not be treated as same-spots Esterman equivalence by default.
• Check that the printout identifies the intended Henson driver-test group and shows the relevant false-positive and false-negative reliability information.
• DRIVE Fields can measure Henson reports on the native lattice, but the final outcome remains manual review because the native Henson lattice is not the same spot layout as the standard Humphrey Esterman. Confirm that the relevant licensing authority will accept the Henson driver-test layout before relying on the result.
• For the binocular driver test, the Henson 9000 report does not print a separate fixation metric; fixation is monitored by the operator during testing using the live camera eye view. Treat fixation/reliability as the limiting issue: any reliance on fixation monitoring needs a separate clinician record of that observation, rather than the printed report alone.

Why there are more lower-field points

Key factThe lower-field weighting is intentional, not a plotting error.

The standard Esterman pattern has 38 superior points and 82 inferior points. That imbalance is intentional: the pattern gives extra weight to lower and central functional field while still checking far-left and far-right horizontal extent.

• The inferior field matters for mobility and driving tasks such as road position, lane markings, steps, kerbs, dashboard/near awareness, and hazards below the line of sight.
• The pattern also retains far peripheral points because horizontal awareness is central to Austroads visual-field thresholds.
• This is one reason Medmont cannot simply be treated as a cosmetic re-label of the Humphrey grid: a different device layout needs its own supported point pattern.

Horizontal band and central 20 degrees

Key factHorizontal extent and central defects are separate checks.

Austroads horizontal extent is measured within 10 degrees above or below the horizontal meridian. On the standard Esterman lattice, DRIVE Fields uses 58 points in the horizontal measurement band; the MRF 124-point layout adds four extra far-horizontal points inside that same band.

• The horizontal extent calculation is last-seen to last-seen. It does not estimate beyond the last tested point and it does not measure to the first missed point.
• The central 20-degree area is a separate safety check. Scattered single misses are treated differently from adjoining clusters within or partly within this area.
• Because there is no y = 0 row on the standard Esterman grid, defects near the horizontal meridian must be interpreted on the tested-point lattice rather than on a drawn geometric line alone.

What the 120 points are testing

Key factThe result is point-by-point seen/not-seen functional sampling with both eyes open.

A Humphrey-style Esterman is a binocular, suprathreshold test. In simple terms, it asks whether the patient noticed a fixed-intensity stimulus at each tested location with both eyes open.

• The output is clinically useful because it maps the combined binocular field rather than each eye separately.
• It does not replace monocular threshold testing for diagnosis or disease monitoring. It answers a different driving-function question.
• A high Esterman score alone is not enough for driving assessment if fixation monitoring, false positives, central clusters, or the test pattern itself are problematic.

Correct lenses, not a near add

Key factUse the correction that best reflects the driving question and document it when it matters.

If the patient normally wears spectacles for driving, or the licence is conditional on wearing spectacles, the field should usually be performed with the relevant driving correction. No near addition is usually required because binocular Esterman is a screening-style test rather than a near threshold test.

• Check the printout and clinical record if lens use could explain a defect, especially with frame rim artefact or unusual peripheral loss.
• The treating optometrist or ophthalmologist still decides the appropriate correction for the individual patient and report.
• If setup, correction, ptosis, dry eye, fatigue, or learning effect may have affected the printout, repeat testing or manual review is safer.

How long does it usually take?

Key factA published HFA3 series found mean Esterman test times of about 5 to 6 minutes.

In clinic, a standard binocular Esterman is usually a short test once the patient is positioned, but it is not instant. A published HFA3 series reported mean test times of about 5 to 6 minutes per Esterman test.

• Real-world time varies with patient response speed, explanation time, trial runs, reliability, fatigue, dry eye, ptosis, and whether the test has to be repeated.
• A roving pathway needs two consecutive tests, so allow longer than a standard single Esterman, plus any break needed for comfort and attention.
• If the patient is slow, anxious, or unreliable, extra time spent improving setup is usually more valuable than a quick but doubtful printout.

Why the printout can look different

Key factA different-looking printout can be acceptable only when the tested locations and reliability data support equivalence.

Different perimeters may print different graphics, symbols, labels, or scales. The key question is not whether the page looks identical, but whether the tested locations, binocular status, fixation information, and false-positive metadata support Austroads interpretation.

• A device can be Esterman-equivalent only if it stimulates the same spots as the standard binocular Esterman or uses another accepted driving layout.
• A custom driving field, monocular-only field, non-120-point layout, or printout with unclear point positions should be treated cautiously.
• When a supported named layout is coordinate-confirmed, DRIVE Fields can show the calculated outcome on that layout. When the grid, reliability evidence, or licensing acceptance is unconfirmed, manual review remains appropriate.

What fixation means

Key factFixation is the anchor for the whole field test.

During an Esterman or Esterman-equivalent test, the patient is meant to keep looking at the central fixation target while light stimuli appear in the surrounding field.

• The test is asking whether the patient can detect peripheral stimuli while looking straight ahead, not whether they can search the screen for lights.
• If the patient looks toward the stimulus, a real peripheral defect can be hidden and a clean-looking printout can become misleading.
• That is why the reliability question is not just whether the patient pressed the button correctly, but whether the field was tested from a stable gaze position.

Why Austroads cares

Key factAustroads requires fixation monitoring to be performed and recorded before a standard Esterman result is treated as reliable.

Austroads treats fixation monitoring as part of the reliability gate for binocular Esterman and equivalent tests used for driver licensing.

• Austroads says significant field defects or progressive eye conditions require binocular Esterman or Esterman-equivalent assessment.
• For alternative devices, equivalence needs both the same tested spots as the standard binocular Esterman and the ability to monitor fixation.
• The false-positive score also has to be no more than 20 percent for an Esterman chart to be considered reliable for licensing.
• If fixation monitoring is missing, unknown, disabled, or not recorded, DRIVE Fields should treat the result as not enough evidence, manual review, repeat testing, or a roving pathway rather than a reassuring standard result.

Eye tracking, catch trials, and manual observation are different

Key factFalse positives are not eye tracking, and not every reliability number proves fixation.

Different devices document fixation in different ways. The important clinical step is to identify which fixation method was actually used and whether it appears on the report or in the clinical record.

• Blind-spot catch trials can monitor monocular fixation by presenting stimuli at the physiological blind spot and checking whether the patient responds.
• That method is limited for binocular Esterman testing because one eye may see what falls in the other eye's blind spot.
• Hardware eye tracking, video iris tracking, webcam gaze monitoring, and manual observation are different ways to document fixation, depending on the device and test programme.
• False-positive and false-negative catch trials test response behaviour and attention. They do not, by themselves, prove that the patient kept looking at the fixation target.
• On camera-less or unsupported hardware, a binocular MRF driving test may still record false-positive and false-negative behaviour, but those catch-trial results do not substitute for active fixation or gaze monitoring.

The binocular Esterman trap

Key factA binocular driving field can look perfect if the patient was scanning the display.

This is the practical reason clinicians need to care. A high score or all-seen grid is only meaningful if fixation and false-positive reliability are established.

• A patient with peripheral loss can sometimes compensate during the test by looking toward suspected stimulus locations.
• If that happens and fixation is not monitored, the printout may resemble a normal field even though the test did not measure the intended straight-ahead functional field.
• Austroads includes roving Esterman as a separate unmonitored pathway, but that pathway has its own safeguards: two consecutive tests, strict false-positive handling, and point-level numeric field output.
• Do not relabel a missing-fixation standard Esterman as acceptable just because the field image looks clean.

Humphrey, MRF, Medmont, and other devices

Key factThe device name does not answer the fixation question.

Use the fixation evidence documented for the actual device, test type, and report. The same brand may use different methods for different programmes.

• For Humphrey HFA binocular Esterman, HFA automatic fixation monitoring is not available, so the practical standard is manual observation of fixation during the test and documentation that this was done.
• Melbourne Rapid Fields uses webcam eye-image analysis and a gaze fixation stability plot for its supported Binocular Esterman Equivalent driving test.
• Camera-based gaze monitoring can document whether the patient looked away from the fixation target, but the final report still needs usable fixation and reliability evidence.
• If MRF is run on a device without a functioning supported camera, treat active gaze monitoring as absent unless the report or clinical record proves another fixation method was used.
• If an MRF report has no gaze plot, no fixation statement, or the camera was disabled, treat fixation as unknown rather than assuming the brand name makes the test reliable.
• Medmont and other devices may have their own fixation or video-monitoring method. Check the actual printout and device settings rather than copying assumptions from another perimeter.

What to check before signing a driving report

Key factA missing gaze plot, fixation-loss line, or manual-observation note is not a small formatting issue.

Before using the field for a driver-licensing report, confirm that the report or clinical record makes fixation and false-positive reliability defensible.

• Find the fixation evidence: gaze plot, fixation-loss result, eye-tracking summary, video/iris tracking status, webcam gaze stability, or documented manual observation.
• Find the false-positive score or count and confirm it is no more than 20 percent for a standard Esterman-equivalent interpretation.
• Confirm the test was binocular when a binocular driving-field assessment is required, and confirm the tested locations match a supported Esterman or equivalent layout.
• For NSW, many clinicians still say RMS, but the current licensing authority is Transport for NSW. The clinician should be able to provide evidence showing how the patient meets or does not meet the Assessing Fitness to Drive criteria.
• If any of these facts are missing, repeat the field with fixation monitoring recorded, use the proper roving Esterman pathway where appropriate, or write a cautious report explaining that reliability is not established.

What roving Esterman means

Key factRoving is a named Austroads pathway, not a label for any unreliable or unmonitored printout.

A roving Esterman is a binocular Esterman pathway conducted without standard fixation monitoring. Austroads lists it as an additional factor for licensing authority review, not as the ordinary first-choice test.

• The practical idea is that the patient is not locked to a monitored fixation target in the same way as a standard Esterman. That may be relevant where the real-world question includes scanning behaviour or adaptation.
• Because fixation is not monitored in the usual way, the reliability burden shifts: Austroads expects two consecutive tests and false-positive counts need to be recorded for each test.
• DRIVE Fields treats more than one false positive on either test as not meeting the app reliability check, and treats one false positive on both tests as manual review because the wording may mean one across the pair rather than one per test.
• It is not the same as simply ignoring a missing fixation-monitoring line on a standard printout.

When to consider it

Key factUse roving only when it genuinely answers the clinical/licensing question better than a monitored Esterman.

Consider roving only when the clinical and licensing question genuinely fits that pathway, particularly when a standard monitored Esterman is unavailable, unsuitable, or being supplemented for adaptation/scanning review.

• It may come up in longstanding field loss, neurological defects, or exceptional-case discussions where the licensing authority wants more functional context.
• It does not relax the horizontal extent, central defect, monocular, or commercial standards.
• If a standard monitored binocular Esterman or validated equivalent can be performed well, that remains the cleaner pathway for DRIVE Fields.

What must be on the printout

Key factFor roving Esterman, two consecutive tests, per-test false-positive counts, and a point-by-point numeric map should be visible.

For a roving Esterman, the printout should show two consecutive tests, the false-positive count for each test, and point-level numeric field output so the tested locations can be reviewed.

• DRIVE Fields asks for the number of roving tests and false-positive counts because a single test is not enough for the Austroads roving pathway.
• A count above one on either test does not meet the app reliability check.
• This means the printout shows numbers or point-level results at the tested locations, not only a shaded picture or total score.
• If both tests show one false positive, DRIVE Fields flags manual review because the Austroads wording can be read as either one allowed per test or one allowed across the pair.

What to do with the result

Key factRoving evidence still needs the same horizontal, central, and pattern review.

Read a roving result as clinical evidence to review carefully, not as a shortcut to a favourable answer. The same field-pattern concerns still matter.

• Check horizontal extent, central 20-degree clusters, hemianopic or quadrantanopic encroachment, and whether missed points are scattered or adjoining.
• If the printout does not show a point-by-point numeric map, or the two tests disagree materially, manual review is appropriate.
• Document why roving was used, what the printouts showed, and whether the licensing authority needs additional information.

National pattern: portal, upload, email, or service-centre lodgement

Key factDo not assume every jurisdiction has a NSW-style clinician portal. Austroads identifies NSW and Victoria as the full online health-professional fitness-to-drive reporting systems.

A harder state-by-state check shows a mixed national pattern: NSW and Victoria have full online health-professional reporting; Queensland has online driver certificate upload and health-professional medical-condition notification; WA has email/post plus Electronic Medical Assessment and DoTDirect in some pathways; ACT has online heavy-vehicle reporting and online visual-acuity upload at renewal; Tasmania has online self-notification; SA and NT mainly publish form, email, post, or service-centre pathways.

• For visual fields, the practical rule is to send the current authority form plus the original machine visual-field printout through the current portal or lodgement pathway.
• Where a portal has an attachment area, attach the Esterman or visual-field printout directly rather than relying on a DRIVE Fields summary as source evidence.
• Where there is no portal attachment pathway, email or lodge the original printout with the form and make the request for licensing-authority review explicit.
• The wording should stay modest: "Original visual-field printout attached for driver licensing authority review under Assessing Fitness to Drive."

NSW: HealthLink upload for Transport for NSW review

Key factYes: in NSW, the original visual-field printout can be attached to the Transport for NSW HealthLink form for Medical Review to consider. Do not rely on a DRIVE Fields report instead of the machine printout.

Many clinicians still say RMS, but the current authority is Transport for NSW. Use HealthLink through the practice system or MyHealthLink portal, select Transport for NSW, then choose the relevant online form such as Vision or Eye Disorder Medical Assessment, NSW Fitness to Drive Medical Assessment, Specialist Medical Assessment, or Medical Condition Notification.

• Complete the clinical fields first, keeping the written comments concise and relevant to fitness to drive.
• Use the form Attachments area to add the original Esterman or visual-field printout, specialist letter, or other critically relevant evidence from the practice record or local drive.
• If requesting authority review of the fields, add a short note such as: "Original visual-field printout attached for Transport for NSW Medical Review. Please review the Esterman/visual-field evidence against Assessing Fitness to Drive vision standards."
• Avoid unrelated attachments or duplicated free text, because the HealthLink guidance warns these can slow processing.
• If HealthLink is unavailable, submit the paper Transport for NSW form with any additional documents using the email or postal address on the form, or follow the patient letter and Service NSW instructions.

Victoria: Medical Review online eyesight report

Key factVictoria uses its own Medical Review online report rather than the NSW HealthLink pathway.

Use medicalreport.transport.vic.gov.au for the online eyesight report and attachment upload. The Medical Review online report can submit reports and attachments securely; after registering or signing in with AHPRA authentication, choose the Eyesight report for ophthalmologists and optometrists when the visual-field issue is the reason for review.

• The Victorian online report includes a dedicated attachment page for supporting documentation relevant to fitness to drive.
• Attach the original visual-field printout and any concise clinical letter needed to explain reliability, field extent, central defects, or conditional-licence reasoning.
• Submit the assessment to Medical Review through the portal and keep the generated reference number or PDF copy for the patient record.
• If the online report cannot be used, follow the current VicRoads/Transport Victoria fallback instructions for emailing, faxing, or posting the paper report and attachments.

Queensland: certificate upload and health-professional notification

Key factQueensland has online medical-condition notification and certificate upload services, but not the same full health-professional fitness-to-drive report portal as NSW or Victoria.

In Queensland, the patient usually gives TMR the Medical Certificate for Motor Vehicle Driver. The driver medical-condition online service can upload a completed medical certificate as a PDF, image file, or Word document, and health professionals can separately notify TMR online, by F4842 form, email, or post when needed.

• For a routine vision review, attach the original visual-field printout or machine report to the medical certificate or specialist/optometry material before the patient uploads or lodges it.
• The driver upload pathway has a small file-size limit, so use a compact PDF if attaching fields.
• If the patient is unlikely to notify TMR, or the clinician needs to report directly, use the health-professional medical-condition notification pathway and include the original visual-field evidence plus any concise clinical summary.
• A practical review sentence is: "Original visual-field printout attached for TMR review under Assessing Fitness to Drive; please consider the field extent, reliability, and central-defect pattern."

Western Australia: email, Electronic Medical Assessment, or DoTDirect

Key factWA does not appear to offer a NSW-style public clinician portal, but its medical assessment instructions list email, post, and Electronic Medical Assessment via MedicalDirector or United Health Group MedEBridge.

For routine WA fitness-to-drive assessment, the Medical assessment certificate: Fitness to drive form is completed with the health professional and returned to the Department of Transport and Major Infrastructure. WA instructions list email, post, and Electronic Medical Assessment. Some passenger transport driver authorisation pathways also allow the doctor to submit directly or the driver to upload a copy through DoTDirect.

• Attach or include the original visual-field printout and any specialist letter with the M107A material when field evidence is important.
• For passenger transport driver authorisation, WA guidance says the health professional may forward the certificate directly or return it to the driver for upload in DoTDirect.
• If using MedicalDirector or MedEBridge, check whether the electronic medical assessment workflow accepts the original visual-field printout as supporting material; if not, email the printout with the certificate.
• If the patient is self-reporting a new medical condition, WA also has an online Report a medical condition form, but that is not the same as a full online clinician assessment portal.

South Australia: Service SA form pathway

Key factSouth Australia currently documents certificate and eyesight forms submitted in person or by post for routine medical/vision fitness-to-drive review.

For SA, use the relevant Certificate of Fitness or Eyesight Certificate pathway. The driver or medical practitioner reports the condition, the health practitioner completes the form, and the completed form is lodged with Service SA as currently directed.

• For a visual-field case, attach the Esterman or equivalent printout and a short clinical note to the certificate material.
• If the case is complex, ask Service SA or the Registrar to review the attached original visual-field printout against Assessing Fitness to Drive rather than relying on a checkbox alone.
• No stable public SA online clinician upload pathway for routine visual-field evidence was found on the official Service SA pages, so check the current instructions before lodging.

ACT: Access Canberra email, post, fax, and heavy-vehicle reporting

Key factACT has online heavy-vehicle medical fitness reporting, but most vision and medical assessment forms are still submitted by email, post, fax, service centre, or renewal upload depending on the context.

For ACT visual-field evidence, attach the original visual-field printout to the relevant Access Canberra medical or visual assessment submission. Visual acuity forms can be lodged online when a licence is due for renewal; at other times, Access Canberra lists email, post, or in-person submission. Medical assessments list email, post, or fax.

• Optometrists are included in the ACT heavy-vehicle mandatory reporting group where the statutory reporting criteria are met.
• For routine visual-acuity renewal, the visual acuity assessment can be submitted online only when the licence is due for renewal; outside that context the listed pathways are email, post, or in person.
• For non-heavy-vehicle review, use the current Access Canberra form and attach the original visual-field printout with a concise request for review under Assessing Fitness to Drive.
• A practical sentence is: "Original visual-field printout attached for Access Canberra review under Assessing Fitness to Drive vision standards."

Tasmania and Northern Territory: online self-report or email/post

Key factTasmania and the Northern Territory do not appear to publish a NSW-style clinician upload portal for routine visual-field assessments.

Tasmania allows medical-condition notification through an online Medical declaration form, by phone, or by self-notification form returned by email or post. The Northern Territory asks health professionals to send the completed assessment form or written summary to MVR by email or post.

• For Tasmania, attach the original field printout to the relevant Transport Services submission or send it with the self-notification material if that is the current pathway.
• For the Northern Territory, the health professional can use the MVR medical form, Austroads medical condition notification form, or written summary, then email or post it with visual-field evidence attached.
• Use a generic wording if the exact portal changes: "The original visual-field printout is attached for driver licensing authority review under Assessing Fitness to Drive vision standards."

If the authority pathway is unclear

Key factThe safest generic instruction is to submit the current form plus the original visual-field printout through the authority current portal, email, post, or service-centre pathway.

Submission methods change more often than the Austroads visual-field rules. If the exact upload pathway is unclear, do not invent one: use the current Driver Licensing Authority instructions and make the attachment request explicit.

• Attach the original visual-field printout whenever possible, not a DRIVE Fields-generated summary in its place.
• Keep the DRIVE Fields report in the clinical record and use it only to help draft your own concise comments if appropriate.
• Use concise wording: "Original visual-field printout attached for review by the Driver Licensing Authority under Assessing Fitness to Drive. Please consider the attached Esterman/visual-field evidence when assessing the licence decision."
• Keep the final-decision language clear: the licensing authority makes the licensing decision; the clinician supplies evidence and recommendation.

Core rule source

Austroads Section 10.2 online chapter

Official online source for the visual-field rules, including Esterman-equivalent testing, fixation monitoring, the 20 percent false-positive threshold, roving Esterman, horizontal extent, and central-field loss.

Core rule source

Austroads Assessing Fitness to Drive PDF

Full AP-G56-22 PDF for checking the whole national standard, appendices, forms context, and language around driver licensing authority decision-making.

Authority contacts

Austroads driver licensing authority contacts

Current national contact list for State and territory driver licensing authorities when a pathway, form, or review destination is unclear.

Authority workflow

NSW health professionals fitness-to-drive page

NSW Government page for clinicians using Transport for NSW medical assessment workflows, including HealthLink SmartForms and the Vision or Eye Disorder Medical Assessment pathway.

Authority workflow

HealthLink Transport for NSW SmartForms

HealthLink support page for Transport for NSW online medical assessment forms and the MyHealthLink portal used by clinicians without integrated practice software.

Authority workflow

Transport Victoria vision and driving

Victorian authority page explaining vision review, visual-field testing, Esterman binocular chart preference, and Medical Review decision-making.

Authority workflow

Transport Victoria online medical report

Victorian health-professional guide for submitting medical and eyesight reports online, including secure attachments and AHPRA-authenticated access.

Clinician quick guide

Optometry NSW/ACT visual-field quick guide

Practical Australian optometry guide on which visual-field test to perform for driving vision, including Esterman-equivalent examples.

Device documentation

Melbourne Rapid Fields online instruction manual

Vendor manual for MRF Online, useful for checking current platform requirements, webcam gaze monitoring, report quality controls, and device-specific workflow.

Device documentation

ZEISS HFA3 Instructions for Use

Official HFA3 instructions. Use this when checking Humphrey Esterman programme details and the HFA binocular Esterman fixation-monitoring caveat.

Evidence and background

Fujimoto 2024: Binocular Esterman reliability

PubMed record for a 2024 study of binocular Esterman test-retest reliability, including lower agreement at peripheral and upper-field points.

Evidence and background

Faraji 2022: Esterman and on-road driving

PubMed record for a study on the predictive value of the Esterman test for on-road driving outcomes, helpful for understanding why clinical judgement remains necessary.

Where the Esterman came from

Key factBenjamin Esterman published the binocular functional scoring grid in 1982, after earlier monocular scoring grids in 1967 and 1968.

The original 1982 paper described a functional way to score the total binocular field, using a weighted grid rather than simply combining two monocular threshold fields.

• The design weighted parts of the field considered more functionally important for human activity, especially central and lower field.
• It was intended for visual capability and disability assessment across industry, law, government, workers compensation, social security, aviation, military, and motor vehicle contexts.
• The modern Humphrey-style binocular Esterman grid uses 120 tested points and became widely adopted because it is quick, binocular, and easy to score.

Was it specifically designed for driving?

Key factIt was not originally designed as a modern on-road driving test.

Driving was one of the practical disability and capability contexts mentioned for Esterman-style functional field assessment, but the grid itself was not built as a prospective crash-risk or on-road driving performance test.

• Driving authorities later adopted the Esterman because it samples binocular functional field, is available on common perimeters, and gives a reproducible point-by-point result.
• This is why Austroads still treats the Esterman as part of a clinical and licensing assessment, not as a stand-alone licensing decision.
• When the printout and real-world safety story disagree, the clinician and licensing authority still need to consider disease, adaptation, cognition, neck movement, glare, contrast, and the driving task.

Validation and limits

Key factThe Esterman is useful and studied, but it is not conclusive for predicting the individual driver.

Recent studies support that Esterman results relate to visual-field damage and functional driving risk, but they also show limits around reliability and individual prediction.

• A 2024 HFA3 study found acceptable overall test-retest reliability, but lower agreement for peripheral and upper-field points.
• A 2022 on-road driving study found more missed Esterman points were associated with failing an on-road test, but the Esterman result alone could not define clear pass/fail criteria for individual drivers.
• That evidence supports the app posture: calculate the Austroads rules carefully, then keep clinical judgement and licensing authority review in the loop.